Tuesday, November 22, 2016

Arkansas long had a reputation for being sickly because much of the state supported large mosquito populations, carrying malaria, yellow fever, and other diseases. Modern medicine, a largely nineteenth-century creation, arrived late, and throughout the twentieth century, diseases eradicated elsewhere continued to flourish. Only after World War II did sharp improvements in health occur, but the Delta lagged far behind. Problems in health and medical programs were compounded in part because many Arkansans deliberately engaged in forms of risky behavior such as tobacco use and unhealthy diets.

Prehistoric Arkansas
The first settlers more than 10,000 years ago brought to the New World only a few major illnesses. One was tuberculosis, evidence of which is visible in bones from burial sites. Open-air living limited the impact of this potentially devastating disease. Modern research shows that the first Arkansans, the Paleoindians, were the healthiest, having a balanced diet of roots, fruits, and fresh meat or fish. Their migratory practices limited the gastrointestinal disorders that came with settled populations. By the Mississippian Period, agriculture flourished, imposing an unbalanced diet of corn and beans on the lower classes, sometimes resulting in pellagra, a disease that later affected lumber and mining communities in the nineteenth century. Evidence of iron deficiency (anemia) has been uncovered in eastern Arkansas.

Sickness was sufficient to produce a class of persons to treat it. Called jongleurs by the French (for they also practiced juggling and magic) and “medicine men” by the Anglo-Americans, these native shamans combined religious incantations with a sophisticated application of herbs and techniques such as sweat baths (vapors). Closely connected was the practice of visiting the springs in what is now Hot Springs (Garland County).

Prehistoric Indians were unequipped genetically with resistance to the Euro-African disease pool that first came to Arkansas with Hernando de Soto in 1541. The subsequent virtual abandonment of Arkansas that French explorers Jacques Marquette and Louis Joliet noted in 1673 could have come about through smallpox, but malaria had arrived as well, putting all Delta peoples at risk. Abandonment may have been gradual rather than dramatic.

The Colonial Period
French settlement began at Arkansas Post in 1686, and reports of sickness appeared constantly in official reports as well as travelers’ journals. There was supposed to be a post surgeon. At least one resident, François Menard, had studied medicine in France but was best known as a merchant, and the post’s garrison and population were too small to support a formally trained physician. The affluent went to New Orleans for medical services.

Sicknesses were common among the newcomers, but the various tribes fared far worse. The Quapaw were hit repeatedly by smallpox after 1698. From perhaps 20,000 in 1600, their numbers fell to 215 by the end of the nineteenth century. Through intermarriage with Europeans, some immunity could be obtained. Contact with Europeans undermined native cultures, predisposing many to alcoholism, which made tuberculosis worse. Respiratory diseases, notably influenza, affected both Europeans and tribes. The biggest and still unsettled controversy concerns syphilis, a venereal disease that became a massive public health problem soon after the discovery of the New World. Other disease include scurvy (vitamin C deficiency), yaws (a skin disease from Africa), diphtheria (sore throat), dysentery, and typhoid fever.

The Antebellum Period
At least one doctor may have arrived prior to the Louisiana Purchase in 1803. Charlatans, as French and Spanish authorities described non-degreed alleged doctors, grew in importance, in part because they were more willing to embrace Indian practices. In the new republic, medical licensing was viewed as aristocratic. Contending “schools” arose, with chiropractic and osteopathy being modern descendants of earlier divergent medical paths. Practitioners were family members, Native Americans, well-meaning tradesmen, slaves, woodsmen, and preachers. Many could handle broken bones, snakebites, gunshot wounds, or arrows embedded in bone or muscle. Fevers were often beyond them, and even the most experienced midwives could not cope with obstetrical complications. Maternal and infant deaths were frighteningly common.

The disease-ridden lowlands lured settlers due to their rich agricultural lands, but many fled from the Arkansas River bottoms to the highlands. One minor improvement came in 1821 when the seat of government moved from Arkansas Post (Arkansas County) to Little Rock (Pulaski County). Doctors, surprisingly, were plentiful. A few of them can be identified: Robert F. Slaughter of Arkansas Post, Peyton R. Pittman of Davidsonville (Lawrence County), Matthew Cunningham of Little Rock, Caleb S. Manley of Batesville (Independence County), N. D. Smith of Hempstead County, and Nimrod Menifee of Cadron (Faulkner County). In 1829, Little Rock had five doctors serving the 250 to 300 residents. Although the ratio fell to one doctor per seventy-eight people by 1836, many, such as Solon Borland, turned from medicine to seek their fortunes in agriculture, law, or politics.

Arkansas’s regular physicians made one major attempt to control admission to the profession. Their 1831 medical licensing bill, which admitted to practice medical school graduates and tested other applicants, was vetoed by Governor John Pope, who proclaimed that “the highest authority known in this land, public opinion,” was superior to diplomas. Unable to get state standards, doctors in Van Buren (Crawford County) established their own county body; others came after the Civil War.

Before the Civil War, three venues of medical training were available to young men. The first was apprenticeship. An established physician agreed to accept a student for a given period of time, during which the physician served as mentor and teacher. The student paid a fee and served as an assistant, borrowed books to “read” medicine, accompanied the doctor on house calls, and observed surgeries. At the end of the apprenticeship, the mentor wrote a testimonial letter, reviewing the areas of medicine mastered by the apprentice, and this letter served in many states as the only credential required for being licensed to practice medicine.

The second venue was the “proprietary school,” or a for-profit medical school, in which a group of doctors owned the school and served as faculty. Each doctor taught the subjects he knew best, and students were required to purchase tickets to a certain number of lectures for graduation. These students never saw a patient during training, and the curriculum was often inadequate, depending entirely on the professional knowledge of the owners. A diploma from a proprietary school was licensure. Although most were regular or “allopathic,” schools were established for competing disciplines.

The third venue was a university medical school. In 1830, twenty-two such institutions existed in the United States, all east of the Mississippi River and all allopathic. Allopathic physicians learned from books and lectures to take “heroic” measures of therapy, believing that any therapy that changed patients’ symptoms was working on the disease itself. Blood letting, blistering, drastic purging, and agents to induce vomiting were employed to excess. Among the medical school graduates in Arkansas in this early period were Matthew Cunningham from the University of Pennsylvania, Alden Sprague from Dartmouth College, and James A. Dibrell Sr. from the University of Pennsylvania. Benjamin F. Scull from Arkansas Post, also one of Arkansas’s first composers, studied at the Medical College of Philadelphia.

In the 1830s and 1840s, another theory of medicine, homeopathy, became widely popular in the region. A German physician with a university background, Samuel Hahnemann, taught that, if a remedy given to a healthy person could produce symptoms of disease, that remedy would cure a patient with those symptoms. Few homeopaths settled in Arkansas before the Civil War, but there were several in Little Rock at the turn of the twentieth century. All too typical was J. H. Gray at Rocky Comfort (Little River County), who doctored sick horses along with dosing out calomel, blue mass, and quinine with no medical education at all.

Doctors also competed to some extent with midwives. No organized midwifery body existed, but many women preferred the presence of female midwives during childbirth. Difficult pregnancies often led to doctors being called in at the last moment. The advantage of an obstetrics practice was that it led to a general family practice; hence, doctors bad-mouthed midwives on both general and financial principles.

Finally, people practiced self-help. One Southern medical book for the home widely used in Arkansas was Tennessean John G. Gunn’s Gunn’s Domestic Medicine, or Poor Man’s Friend (1830), which was revised and reprinted for at least ninety years. Gunn gave special attention to the needs of women. The Reverend D. L. Saunders, MD, of Little Rock authored Woman’s Own Book: Or, A Plain and Familiar Treatise on all Complaints and Diseases Peculiar to Females in 1858. Planters especially relied on books in treating their slaves, and plantations were sickly places, both for blacks and whites, largely due to their geographic location in the lowlands. A great source of misinformation came from patent medicine advertisements. Throughout the state, women—especially those with an Indian background—were called upon to supply herbal remedies.

Epidemics occasionally interrupted the normal life cycle. The Mississippi River was an artery from the disease-rich tropics to the heartland. Helena (Phillips County) was regularly threatened. Editor James M. Cleveland of the Democratic Star died in the yellow fever epidemic of 1855 as many of the town’s residents fled. Cholera accompanied the Cherokee and other tribes during their forced migrations west. Cholera and other diseases also affected parties heading to the California gold fields. This disease, which hit Fort Smith (Sebastian County) before the Civil War, was marked by extreme dehydration, but the standard textbook treatment was to deny the patient any liquids.

Civil War through Reconstruction
During the Civil War, Arkansas became part of the Confederate Department of the Trans-Mississippi, a sprawling, poorly organized area of 700,000 square miles, reaching to Arizona and New Mexico. After the frightful carnage at the Battle of Shiloh (April 6–7, 1862), a group of Confederate surgeons met in Little Rock to create an examining board to recruit physicians for the Southern army. Doctor Philo Oliver Hooper, a graduate of the Jefferson Medical College in Philadelphia, practiced in Little Rock; later he would return to Little Rock, reestablish his practice, and help establish a medical school.

Medicines, especially quinine, were in short supply. Battle wounds were often compounded by fractures. Sanitary (antiseptic) practices had not yet been scientifically established, and the two forms of anesthesia, ether and chloroform, were used less than a fourth of the time. Many amputees died from shock. Nursing was only beginning to admit women; the first official female nurse, Mary Phelps, was the wife of John S. Phelps, the Union military governor of Arkansas. Post-operative care was lacking, and in towns, schools and churches were appropriated for hospitals.

The civilian population suffered malnourishment, especially in winter 1864. Cholera, which invariably followed armies, did not limit its damage to military personnel and arrived in force in 1866 and 1867. Nevertheless, the Civil War produced a medical revolution. Government studies documented medical treatment and photographed specimen patients. Organized female nursing followed, as did the building of hospitals. Two years after the war, Joseph Lister identified sepsis and brought in carbolic to fight infection.

The end of slavery had pronounced negative medical effects. The Freedmen’s Bureau found itself almost powerless while white authorities ignored the high death rate among African Americans. Left almost entirely to their own devices, most relied on “root doctors” or “conjurers.” One of the former, Patience Brooks Trotter of Monticello (Drew County), was highly regarded even by white physicians because of her successes in handling “female complaints” and cancers.

After Reconstruction, some graduates of black medical schools, notably Meharry Medical College in Nashville, Tennessee, served a small part of the black population. Most located in towns, for while the needs were greater in the rural areas, patients there could not afford to pay. Little Rock, Pine Bluff (Jefferson County), Helena, Forrest City (St. Francis County), and Newport (Jackson County) were served by doctors and dentists. The customers’ poverty was reflected in the career of Dr. William D. Black, who relied on the income generated from the plantation lands of his father, Pickens Black. Dentistry was a particularly sore point, for while some white doctors would see black patients, white dentists usually refused to do so.

The Foundations of Modern Medicine, 1870–1920
The foundations for future progress started with organizing and establishing medical licensing. Shortly after the end of the war, Hooper and twelve medical colleagues organized the Medical Society of Little Rock and Pulaski County. Then, on November 21, 1870, a group of physicians from around Arkansas met at the Little Rock Pacific Hotel to establish a statewide medical society. The yellow fever panics of the 1870s spurred a state licensing law.

When yellow fever struck Memphis in 1873, Little Rock was flooded by refugees. Luckily, they did not bring the disease with them. In 1878, a Little Rock board of health sprang into operation when “yellow jack” was first reported in New Orleans. Other communities followed suit, with “shotgun” quarantines being common in small towns and rural areas. The chaos that followed prompted demands for a coordinated state policy to work with the Sanitary Council of the Mississippi River, a multi-state coordinating body. In the absence of legislative action, Governor William Read Miller appointed the Little Rock board as the de facto state body, which at least legitimized its existence and allowed it access to funds from the National Board of Health. With more than $7,500 in aid, the board in 1879 established quarantine stations to keep that year’s epidemic from expanding.

Quarantines operated both regionally and locally. As the nation’s transportation grid increased, it became increasingly difficult to block all human contact. Locally, communities set up pest houses, leaving sick people there to die. If that could not be used, a black flag outside a house warned those in not to leave and others not to come. In the case of smallpox, death was followed by the destruction of all clothing, bedding, and other property.

The existence of a temporary board of health in Arkansas dated back to 1832 in Little Rock, but the de facto board of 1879 led Arkansas into uncharted waters. Dr. Charles Nash, the 1879 president, for example, called attention to adulterated and impure foods. In 1881, the legislature did establish a state board of health, but lacking in the law were requirements for death, marriage, birth, and other statistics that had become routine elsewhere in the nation, and the funding was adequate only for a small staff.

In the absence of any outbreaks, the board became inactive until 1897, when smallpox surprised the state. Salem (Fulton County) was the center, and local doctors at first failed to recognize the disease that eventually spread across the state. Galloway College in Searcy (White County) and Beavoir College at Wilmar (Drew County) were both hit. Despite some 7,000 to 10,000 cases yearly, legislators rejected inoculations, with country doctor and long-time legislator W. H. Abington saying that they did not work.

Medical licensing legislation also dated to 1881, but this “Quack Law” grandfathered in all existing practitioners and required “doctors” only to appear before a county board, which not need even have a doctor on it, and register with the county clerk. Those utterly ignorant of medicine could go to Benton (Saline County) and appear before the Saline County Board, which between 1881 and 1891 certified 149 doctors although the entire county contained only eleven physicians.

Not only was the state overrun by incompetents, but fraud was rampant as well. Hot Springs, where the baths were a major medical drawing card, had a problem with physicians and boarding houses who hired “drummers” to steer in customers. Seriously ill persons, especially on arriving trains, were victims of these scams, and the national scandal prompted a state law in 1903 and federal legislation in 1904. A constitutional argument in favor of medical commercial freedom was rejected by the state Supreme Court in Thompson v. Van Leer (1906).

Closely connected to medical licensing was the rise of hospitals. Arkansas’s first hospital (today called Sparks Regional Medical Center) was founded in Fort Smith in 1887. The following year, the Sisters of Charity of Nazareth, a Roman Catholic order of nuns, opened Charity Hospital, now St. Vincent Infirmary in Little Rock. The Sisters of Mercy then established Saint Joseph’s Hospital—known as St. Joseph’s Mercy Health Center and then renamed Mercy Hot Springs in 2012—in Hot Springs. In 1892, Isaac Folsom of Lonoke (Lonoke County) made a bequest in his will to endow a free clinic bearing his name in Little Rock to be used for teaching. The widow of Colonel Logan H. Roots, furthering her husband’s dream of a city hospital, gave funds in 1895 to construct a city hospital on land purchased by the City of Little Rock. In 1896, the new hospital, under-funded and poorly equipped, opened its doors with seventy-five patient beds. In 1900, the Olivetan Benedictine sisters at Holy Angels Convent founded Saint Bernard’s Hospital, now St. Bernards Medical Center, in Jonesboro (Craighead County). Public support for improved standards of medical education and healthcare seemed to be building in Arkansas.